Immature granulocyte count on the new Sysmex XN-9000: performance and diagnosis of sepsis in the intensive care unit

Buoro, Sabrina; Mecca, Tommaso; Vavassori, Mauro; Azzarà, Giovanna; Esposito, Sergio; Dominoni, Paola; Papagni, Gabriele; Marchesi, Gianmariano; Ottomano, Cosimo; Crippa, Alberto; Lippi, Giuseppe

doi:10.22514/sv102.122015.4

Cited by 6 publications

(4 citation statements)

References 6 publications

(6 reference statements)

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“…Karon et al [ 18 ] reported that the IG% and IG count were of limited utility in predicting sepsis in a study of patients admitted to the emergency department. Additionally, unlike the findings of our study, Buoro et al [ 19 ] reported that an IG < 10.0% was a valid cut-off for the diagnosis of sepsis in ICU patients. Ayres et al [ 20 ] reported that an IG% < 2.0% was adequate for excluding sepsis as a diagnosis.…”

Section: Discussioncontrasting

confidence: 99%

Immature granulocyte percentage for prediction of sepsis in severe burn patients: a machine leaning-based approach

et al. 2021

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Background Of the existing sepsis markers, immature granulocytes (IG) most frequently reflect the presence of an infection. The importance of IG as an early predictor of sepsis and bacteremia is evaluated differently for each study. This study aimed to evaluate the effectiveness of the Sysmex XN series’ IG% as an independent prognostic indicator of sepsis using machine learning. Methods A total of 2465 IG% results from 117 severe burn patients in the intensive care unit of one institution were retrospectively analyzed. We evaluated the IG% for sepsis using the receiver operating characteristic, logistic regression, and partial dependence plot analyses. Clinical characteristics and other laboratory markers associated with sepsis, including WBC, procalcitonin, and C-reactive protein, were compared with the IG% values. Results Twenty-six of the 117 patients were diagnosed with sepsis. The median IG% value was 2.6% (95% CI: 1.4–3.1). The area under the receiver operating characteristic curve was 0.77 (95% CI: 0.78–0.84) and the optimal cut-off value was 3%, with a sensitivity of 76.9% and specificity of 68.1%. The partial dependence plot of IG% on predicting sepsis showed that an IG% < 4% had low predictability, but increased thereafter. The interaction plot of IG% and C-reactive protein showed an increase in sepsis probability at an IG% of 6% and C-reactive protein of 160 mg/L. Conclusions IG% is moderately useful for predicting sepsis. However, since it can be determined from routine laboratory test results and requires no additional intervention or cost, it could be particularly useful as an auxiliary marker.

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Section: Discussioncontrasting

confidence: 99%

Immature granulocyte percentage for prediction of sepsis in severe burn patients: a machine leaning-based approach

et al. 2021

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“…In comparison studies, all routinely used CBC parameters were comparable and showed very high correlations between BC‐6000 and Sysmex XN with the same samples in terms of clinical usefulness by the Passing‐Bablok and Bland‐Altman analyses . And also, for the leukocyte differential parameters, BC‐6000 and manual microscopy have more consistent results, especially for monocytes and immature granulocytes when compared to the previous report . For the flagging ability studies of blasts, the sensitivity, specificity, and overall efficiency of BC‐6000 are 82.9%, 82.4%, and 82.6%, and it is an excellent performance for common clinical laboratory and better than Sysmex XE‐2100, which was reported to result in a very high rate of manual slide review in detecting blast, but a less specific and remarkable increase in the workload in the laboratory.…”

Section: Discussionmentioning

confidence: 56%

“…22 And also, for the leukocyte differential parameters, BC-6000 and manual microscopy have more consistent results, especially for monocytes and immature granulocytes when compared to the previous report. 8,23,29 For the flagging ability studies of blasts, the sensitivity, specificity, and overall efficiency of BC-6000 are 82.9%, 82.4%, and 82.6%, and it is an excellent performance for common clinical laboratory and better than Sysmex XE-2100, 30 which was reported to result in a very high rate of manual slide review in detecting blast, but a less specific and remarkable increase in the workload in the laboratory. This phenomenon is inconsistent with the flagging performance of Sysmex XN (97%) which was reported by Seo.…”

Section: Throughput Studymentioning

confidence: 99%

Clinical performance evaluation of the new hematology analyzer Mindray BC‐6000

Shen

Cao

Zhou

et al. 2019

Int J Lab Hematology

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Introduction With the progression of blood analysis technology, hematology analyzers become more complex and diverse. How to choose a superb instrument is a challenge for the laboratories. In the essay, we studied whether the newest BC‐6000 hematology analyzer meets the needs of a clinical hematology laboratory. Methods Methods comparison was performed using 350 blood samples from patients between different measurement procedures; the basic analytical performance was also tested, including the throughput, carryover, precision, and linearity in different modes. The flagging performances for blasts, immature granulocytes, and NRBC were compared with manual microscopy. Results There were minimal carryover (<0.30%) and excellent actual blood linearity for all routinely used parameters concerned by the clinicians (R2 ≥ 0.997). Repeatability and reproducibility were satisfactory at all testing levels. The functional sensitivity of leukocytes and platelets in the blood and leukocytes and erythrocytes in body fluid was excellent at the 20% CV level. BC‐6000 and XN displayed very high correlations for complete blood count (CBC) parameters and very high consistency for leukocyte differentials and NRBC compared with manual microscopy. BC‐6000 showed excellent sensitivity and specificity flagging ability on blasts (82.9% and 82.4%) and NRBC (80.0% and 96.9%). For immature granulocytes, BC‐6000 showed excellent sensitivity but common specificity flagging ability (91.7% and 65.6%). Conclusion The clinical performance of BC‐6000 is excellent, and the analyzer can provide timely and accurate reporting for most of the small‐ to large‐scale laboratories.

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“…Nonetheless, neutrophils in the form of left shift remain an important part of sepsis pathobiology and the body's response to infection, and are considered one of the earliest indicators of sepsis. Studies done by Buoro et al, 12 Bourne et al, 13 MacQueen et al 14 , and others have validated immature granulocyte count by Sysmex as an indicator of the left shift and thus sepsis.…”

Section: Discussionmentioning

confidence: 98%

Evaluation of Immature Granulocyte Count as the Earliest Biomarker for Sepsis

Gupta¹,

Sharma²,

Gupta³

et al. 2022

Indian Journal of Critical Care Medicine

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Background Diagnosing sepsis early is important for its successful management. Various biomarkers are being used currently, but mostly they are either expensive or not readily available. This study aims to evaluate usefulness of automated immature granulocyte count (IG#) and immature granulocyte percentage (IG%) as early diagnostic markers of sepsis and compares it to other established predictive markers. Patients and methods In this prospective observational study, 137 eligible, critically ill, nonseptic intensive care unit patients were analyzed for automated IG#, IG%, serum procalcitonin (PCT), and blood lactate (Lac), daily for 7 days after recruitment. Patients were followed for the development of sepsis, defined by the new Sepsis-3 criteria. The study was divided into four time periods of 24 hours each with respect to the day of developing organ dysfunction. Using area under receiver operator characteristic and diagnostic odds ratio (DOR) methods, the best biomarker for the prediction of sepsis in each time period was calculated. Results IG# and IG% were the earliest biomarkers to have a significant discriminating value with area under the curve of 0.81 and 0.82, respectively, as early as 24 hours before clinical sepsis is diagnosed by Sepsis-3 criteria. Both IG# and IG% have a high DOR of 34.91 and 18.11, respectively, when compared to others like PCT and Lac having a DOR of 27.06 and 4.78, respectively. Conclusion IG# and IG% are easily available, rapid, and inexpensive tools to differentiate between septic and nonseptic patients with high specificity and sensitivity. It is the earliest biomarker to show a significant rise in patients developing sepsis. How to cite this article Bhansaly P, Mehta S, Sharma N, Gupta E, Mehta S, Gupta S. Evaluation of Immature Granulocyte Count as the Earliest Biomarker for Sepsis. Indian J Crit Care Med 2022;26(2):216–223.

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Immature granulocyte count on the new Sysmex XN-9000: performance and diagnosis of sepsis in the intensive care unit

Abstract: Introduction. The amount of immature leukocytes reflects marrow response to bacterial infection, and this may be

Cited by 6 publications

References 6 publications

Immature granulocyte percentage for prediction of sepsis in severe burn patients: a machine leaning-based approach

Immature granulocyte percentage for prediction of sepsis in severe burn patients: a machine leaning-based approach

Clinical performance evaluation of the new hematology analyzer Mindray BC‐6000

Evaluation of Immature Granulocyte Count as the Earliest Biomarker for Sepsis

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